Healthcare Provider Details

I. General information

NPI: 1841612967
Provider Name (Legal Business Name): KENNEBEC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SECOND ST
FARMINGDALE ME
04344-2931
US

IV. Provider business mailing address

14 SECOND ST
FARMINGDALE ME
04344-2931
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-9898
  • Fax: 207-582-9899
Mailing address:
  • Phone: 207-582-9898
  • Fax: 207-582-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7000